A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
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Wednesday, 30 November 2016

ECG of the Week - 28th November 2016 - Interpretation

The following ECG's are from a 62 yr old female who presented with chest and epigastric pain. The first ECG was performed by the patient's GP and the second ECG on arrival in the Emergency Department. Her pain was ongoing at the time of both ECG's and she has a past medical history of hypertension, obesity and T2DM.

This all seemed very straight forward until we reviewed the patient and found all the leads to be in the correct position !!Remember ECG's are complicated machines with multiple connections and just because the one connection with the patient appears to be correct doesn't mean there isn't a problem elsewhere. So we removed the ECG machine from the situation, the patient was completed disconnected from the usual machine and a new recording was performed on a portable ECG machine, i.e everything in the process after the patient was replaced. The following ECG is below:

ECG repeated on different ECG machineClick to enlarge

Comparing with the prior ECG's we can see resolution of the complete lead inversion and axis change seen in the second ECG with the overall morphology similar to the ECG performed at the GPs. I suspect the change in appearance of aVL between the 1st and 3rd ECG reflects both patient and lead positioning during ECG recording.It turned out the culprit was a damaged cable connection between the patient leads and ECG monitor unit !!References / Further Reading